What do you do if you start bleeding after sex during menopause?

How does the postcoital bleeding journey proceed after menopause?

Today let’s talk about the causes and some investigations or tests you should have when you start bleeding after sex once you hit menopause.

Key Events At Menopause

Menopause means the end of menstruation and is the time when a woman gets to the end of her reproductive cycle.

 Here are the things that happen in menopause:

• your body stops making hormones like Oestrogen
• your ovaries stop releasing eggs regularly
• you stop having regular periods.
• When you have not had periods for 12 consecutive months, we say you have reached menopause.

 Menopause is “technically” not a health condition, as many women come to this stage of their lives without any problems.

 However, a small group of ladies can experience distressing symptoms before, during or after menopause.

Please check out our videos to learn about menopause symptoms.

Many women are likely to start the transition into menopause around 45 years or so. Most reach menopause at about 48 to 51 years on average.

Sexual Problems During Menopause

When it comes to sex, many things around menopause can lead to bleeding problems. Let’s look at 3 of them. 

No desire

• No desire for sex, possibly due to culture, the pressure of life, work, busy family etc.
  • This may happen as woman ages or approaches the age when menopause sets in. Some women believe they can not enjoy or have sex as they age.
  • It may be a cultural thing where a woman feels she has ‘dried up’ and thus cannot enjoy sex. It may also be from pressure at work, business, being a caregiver or supporting the family, so there is “no time” for sex.
  • Loss of libido can also be associated with low mood or depression. Mental health issues may happen at any age and not necessarily be associated with menopause.
  • Whatever the cause, no desire for sex can affect your sexual encounter.
  • Women who desire sex become aroused during foreplay, which builds during intercourse. From arousal, your body makes lubricating fluids moisten or wet the vagina, making intercourse easier and more enjoyable. If this is absent, friction during sex can cause bleeding.

Hormones

• During menopause, women experience the effect of reducing hormone levels, particularly low Oestrogen.
  • Here is another factor that affects the vagina as well. Oestrogen is the hormone that keeps the cells of the vagina plump.
  • As Oestrogen reduces, the cells of the vagina become thin and shrink. Essentially it means the vagina tissue itself does become drier and may shrink.
  • This is known as atrophic vaginitis, which makes having sex painful and can lead to bleeding after sex. Check out this video on 15 causes of painful vaginal sex. 

Medical Conditions that Cause Menopause Bleeding After Sex

• The risk of specific health problems like cancer increases as women grow older. This means that conditions like cervical, womb or vulval cancer are more common as women age.
  • The changes in the health of the cells as cancer develops make bleeding after sex one of the symptoms in any of these conditions.
  • Certain skin conditions can also fall under this category. One of them is called Lichen sclerosis.

Pelvic Infections

• Infection – sexually transmitted diseases can happen in women after menopause if they are exposed to the germs from a partner.  

Treatment: Menopause Bleeding After Sex

So how does the postcoital journey in menopause run?

The usual story goes like this:

A woman who has stopped having her periods suddenly develops some bleeding during or after sex.

 It may be heavy or light (like spotting).

The bleeding may occur with or without pain. There may or may not be other symptoms, like vaginal discharge or itching.

These events should prompt a visit to the doctor. They will take a lot more information from you and arrange a physical examination. 

The symptoms mustn’t be ignored, please.

Doctor’s Assessment of Postcoital Bleeding After Menopause

 Remember we said that at menopause, certain conditions like cancer occur more often?

So we must arrange tests to see if the cause of postcoital bleeding is from grave causes like cancer of the cervix or womb cancer. 

The assessment starts with the doctor’s questions to explore the symptoms and then a physical examination.

Some of the questions are:

1. How long has the bleeding been going on? At this age (menopausal), and if the bleeding after sex has been going on for four weeks, we will have strong concerns about cancer.
2. Are you up to date with your cervical smears?
3. Have you had previous abnormal smears? If yes, what treatments did you have?
4. Has there been any weight loss, night sweats or appetite loss?
5. We will also ask about sexual partners because any person having sex with a new partner or more than one partner is at risk of an STI (sexual infection). 

Physical Examination and Tests

The physical examination will involve an intimate examination of the vagina and cervix using the speculum.

This may reveal skin conditions like LS. It might also show the vagina is atrophic. In addition, there may be other changes like ulcers or an abnormal appearance in the vagina, vulva or cervix. 

Depending on the initial findings, the next step includes arranging a pelvic scan or referring directly to the gynaecologist for more specialised tests.

These can include a camera test to visualise the cervix and womb, taking tissue samples from these areas and so on to identify cancer if it is present.

Treatment will vary and depend on the cause in each case of menopause bleeding after sex.

The key takeaway is that it should never be ignored; it is vital to establish a cause. 

Many times the causes can be treated – infection, atrophic vaginitis, or friction associated with low libido from mood problems or stress can be addressed in different ways.

Detecting cancer and treating it early is extremely important, so we encourage women not to ignore this symptom.

More Reading

• An Age Thing? …What Menopause Means to You
• What is a Rectal Examination?
• Menopause Symptoms and Treatments – Know When to See a Doctor?
• How Menopause Affects Black Women
• Common Changes in Menopause

Editing By AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are written by practising  Medical Practitioners on various health care conditions to provide evidence-based guidance and to help promote quality health care. The advice in our material is not meant to replace the management of your specific condition by a qualified health care practitioner.
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